Archive for the ‘Healthcare’ Category

Two years ago, the Medical Education Partnership Initiative (MEPI) was launched to increase the quality, quantity and retention of health care workers and the faculty needed to train them. The program is investing about $130 million over five years through direct awards to African institutions in a dozen countries. Within this initiative is the emphasis of preventive care training at medical schools. In Africa, the correlation between preventive care training and non-communicable diseases is particularly important.

Unhealthy diets and physical inactivity are key risk factors for the major non communicable diseases such as cardiovascular diseases, cancer, and diabetes. While Africa faces a double burden of infectious and chronic diseases, infectious diseases still account for at least 69% of deaths on the continent. If there is to be a shift in focus from curative to preventive care, the medical school curriculum must include nutrition and physical activity education. So far, MEPI has led to a fundamental change in the way African institutions and government leaders approach medical education. Institutions are changing curricula content and expanding the breadth and depth of subject matter that emphasize the importance of preventive care.

In Durban, South Africa, the University of Kwa-Zulu Natal (UKZN) is expanding its approach to the HIV/AIDS epidemic. The university has packaged a series of workshops called “Me and HIV,” to enhance sensitivity about HIV/AIDS among health workers. These workshops examine the myths, realities, attitudes and perceptions of HIV/AIDS, prevention strategies and how to help people learn to live with their condition. Emphasizing the importance of preventive care through medical school is crucial in creating sustainable prevention-oriented physician practices. The role of the physician is vital since patients cite their physician most often as the one who influenced them most to make a health behavior change. If MEPI remains successful, medical education in Africa will have a positive impact on people’s health in the continent.

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Last month, the Global AgeWatch Index issued a report on the quality of life of older people in 91 nations. The report included several factors such as income security, health and well-being, employment and education. African nations did not fare well. South Africa was the highest ranked African nation at number 65 while Ghana, Morocco, Nigeria, Malawi, Rwanda and Tanzania came in at numbers 69, 81, 85, 86, 87 and 90 respectively. Other African nations were not included in the report because there was not sufficient data. With South Africa leading the pack in elderly well-being, it helps to decipher the various ways it deals with its senior citizens.
In addition to having the largest and most developed economy in Africa, the old age pension reaches 72% of the older population in South Africa. South Africa’s pension system is the second most distributed of the African countries that are in the Index. Namibia is the first at a whopping 167.3% although there was not enough data in other areas to include the nation in the report. While South Africa performed moderately well in income security, they ranked low in elderly’s health status. There are only eight registered geriatric doctors to serve an older population of 4 million. Since 1994, dramatic changes have taken place in the structure of health services. The government prioritized maternal and child healthcare because of the HIV/AIDS pandemic in the 90’s.

Although South Africa was ranked at number 65, Bolivia, one of the poorest countries on the list was ranked at number 46. This shows that higher-income does not always correlate with better quality of life. In fact, some lower-income countries that invested in aging saw positive impacts. Bolivia, for instance, implemented a national plan on aging and free health care for older people, which vastly improved quality of life. The rankings illustrate that limited resources need not be a barrier to countries providing for their older citizens, that a history of progressive social welfare policies makes a difference, and that it is never too soon to prepare for population aging. This is important for other African nations because the elderly are a significant boon. As African nations, we can do better by learning from each other as well as other non-African nations. Our collective goal is to improve the elderly’s quality of life for present and future generations.

The “Brain Drain” is a common term used to describe the flight of human capital or the large scale emigration of individuals with technical expertise and/or education from a given region. Sub-Saharan Africa has been one of the chief victims of the brain drain over the last half century. It is estimated that one-fifth of African-born physicians and one-tenth of African-born nurses are currently practicing overseas. In this post, I sit down with Femi Taiwo, a current Master’s of Public Health candidate and former Senior Medical Officer with the Federal Medical Center in Lagos, Nigeria, to discuss his own story, his thoughts on Africa’s brain drain crisis, and his beliefs on what would encourage young, African medical professionals to return or choose to stay on the continent.

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Name: Femi Taiwo

Age: 38

Degrees Earned: MBBS (Nigeria, 2004), MPH (US, Dec. 2013)

Positions Held: Worked as a general practitioner (Senior Medical Officer) with Federal Medical Center, Lagos, Nigeria and also with a private clinic in Lagos (locum).

What was your motivation for choosing to further your education overseas?

My motivation was the desire for capacity building and to improve my then current job skills. Also, job satisfaction and good remunerations were among other factors considered.

Would you encourage more African medical professionals to move abroad or to practice their trade on the continent?

Yes, even though it is a decision for individual. I encourage more African medical professionals to move abroad even if it is for a brief period to see how things are being done differently. After this, they can return home to add value and expertise to medicine being practiced on the continent.

Do you feel the quality of education in Nigeria adequately prepares medical professionals for the population they serve? Please explain

To some extent, yes. Nigeria is a developing country which is very rich in both human and natural resources, but due to poor and corrupt leadership, it’s medical practice is still very rudimentary. There are not enough hospitals and the few that exist are ill-equipped. A large percentage of the populace is living below the poverty line. So, the medical education is on par with the reality of the socioeconomic and political reality of Nigerian society. Here is an example: if a patient presented with a complaint of a persistent headache, here in the United States, a brain CT scan must be requested as part of the initial evaluation. The medical education in Nigeria and a host of other African countries will not teach that because of the socioeconomic situations of the vast majority of the populace (Remember, the majority of patients pay from their pockets because they lack medical insurance). Another example would be that in Nigeria, you would rather ask for a blood film for the malaria parasite because as they say “common things occur commonly”. It would amount to a total failure for any medical student in Nigeria to say that a brain CT scan will be his or her first line of investigation in a case of persistent headache.

What incentives do you think would encourage those in healthcare to stay in-country?

Incentives to keep those in healthcare to stay in-country would be to provide opportunities for self development, increase job satisfaction by providing updated medical equipment and technology, and provide adequate and commensurate remuneration. All the above can only be achieved if there is transparent governance, so political reform to ensure responsive, transparent governance is fundamental to achieving these aims.

What do you believe is the most pressing issue in African healthcare today and how can it be improved?

The most pressing issue in African healthcare today is access to quality care which is compounded by a lack of qualified health workers. This is made worse by the continuing brain drain and poor socioeconomic situation created by bad leadership across Africa. Solutions to this myriad of problems will have to begin by ensuring transparent governance, stop/reduce the brain drain in the health sector, improve the conditions of service, train more health workers, build more clinics and hospitals, and improve the socioeconomic conditions of the people through gainful employment.

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This past month South Africans have been on edge. Nelson Mandela has spent four weeks in a Pretoria hospital with a recurring lung infection. While we hope that Mandela’s health improves, there are at present senior citizens who cannot afford sufficient medical care in South Africa. The situation is more problematic because advocates for the elderly state that the services for senior citizens have dramatically decreased in the last two decades.

According to Anita Powell, Southern Africa reporter for Voice of America, few among South Africa’s rapidly growing elderly population are faring well, health wise, due to economic insecurity which is linked with better health outcomes. Elderly advocates insist that Mandela is not the standard by which South Africa’s treatment of its weakest members should be judged because the nation’s growing elderly population is increasingly marginalized by a government that has focused its health care on the young. While child health is very important, the health care needs of the elderly should not be overlooked especially in a nation with only eight registered geriatric doctors (International Longevity Center-South Africa). This video portrays the work of the Ikaheng Daycare Centre for the Aged in the South African Township of Ikaheng.

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This write-up is a continuation of our discourse on the Zambian Malaria Initiative. Click here to read Part 1 of the blog post. This initiative was introduced by the Zambian National Government and a host of international partners to eradicate malaria from Zambia.

After reading Part 1 of the write-up and perhaps other write-ups on this topic, I hope the reader will ask the same questions I asked. “How can this effort be sustained? Will funding costs allow it to be replicated successfully in other malaria-endemic African countries?”. In 2006 and 2008, the Zambian malaria eradication project costs approximately $35 million and $40 million respectively. This implies huge financial implications for all funding parties. Hence, any event that prevents Zambia’s international partners from future funding of the project means that all past gains will be relinquished.

Perhaps a better question to ask is: How can public health interventions, especially in resource-poor settings become more efficient? What new and innovative techniques are been applied to reduce costs, in malaria and other disease intervention programs in Africa? Please comment and share what you know or what you are doing.

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In this post, Guest Blogger Udo Obiechefu attempts to start a conversation on some of the issues impacting access and availability of care in West Africa. In his next post, Udo will explore avenues for solving these issues. Enjoy!

The issues related to health care delivery and access in West Africa is plentiful. Lack of adequate funding, a small workforce, poor organization, and a dearth of viable private sector solutions are just a few of the many dilemmas preventing countless West Africans from attaining sustainable access to quality care. Discussions addressing these issues are numerous and ongoing. I will attempt to contribute the discussion by starting a conversation revolving around three major dilemmas facing West African healthcare. In part two we will discuss possible solutions.

Part 1: The Problems

The Private Sector: Is Private Health Insurance Realistic?

A problem that is evident within the realm of West African healthcare is the lack of an adequate, cost appropriate private sector market. Much of this is due to the fear of high costs and conjecture surrounding the profit motives of potential investors. Although these suspicions may be warranted due to the insurance industries checkered history in other parts of the world, it is important to acknowledge the lack of strong private sector options as another problem plaguing healthcare access in West Africa. Because of the high out of pocket expenses encumbered by those seeking medical services, healthcare providers have difficulty predicting the flow of revenue. This lack of predictability has lead to the inability of providers to improve the quality of services. As a result of this and many other factors the private sector has remained underutilized.

The reality is that West Africans have proven capable of and willing to prepay for services. This is evident in the success of prepaid cellular cards. Of course, the healthcare market has many complexities and comparisons with the mobile telecommunications market can be a stretch, but what is evident is the basic premise of prepayment is not a foreign idea. The problem resides in the fact that consistent access to quality medical care can be difficult to come by. Questions must be asked about how private insurance can better provide realistic options for citizens of West Africa. What options are available for middle income West Africans? Can the private sector play a role for those living in poverty? More work has to be done in researching all possible avenues for improving the health of West Africans. At this point in time the lack of a competitive private health insurance market has to be viewed as a deficiency.

Staffing: Understaffed, Overworked and Unemployed

The World Health Organization recommends, as a minimum standard, one physician for every 5,000 inhabitants of a geographic area. Many West African nations fall far short of this criteria. Burkina Faso, Benin, Senegal, Sierra Leon, Niger and Mali all average less than ten physicians per 100,000 inhabitants. This staffing crisis is also present in nursing and hospital administration. Despite the fact that Africa, as a continent, accounts for over 40% of the worlds communicable diseases, it comprises less than five percent of the global health workforce. Unfortunately West African nations are not producing healthcare workers at the rate of demand. Also troubling is the fact that many of the healthcare workers who are available are located in larger cities which leaves those in rural areas an additional burden.

Notwithstanding the issue of shortage, there is also the issue of funding. There are many nurses and midwives who are underemployed or unemployed in West Africa. This is due to nations lacking the financial ability to meet even modest salary demands. This has caused many capable medical professionals to leave the region in hope of finding more opportunity elsewhere. West Africa is being devastated by a “brain drain”. Due to economic, social, and personal reasons well educated, qualified and motivated healthcare professionals in West Africa are seeking opportunities in the west. Europe and North America are reaping the rewards of West African educated healthcare professionals. These issues have lead to an over reliance of many *ECOWAS governments on skeleton staffing or temporary foreign health workers. This dependency has produced a system where instead of making systemic changes to the current healthcare structure that would aid in the production and maintenance of a larger workforce, there is a culture of anticipation and need for the next available foreign assistance to provide relief to a poorly functioning arrangement.

Healthcare Financing: “…..Or lack thereof”

Donor funding accounts for 25% of healthcare financing in one third of African nations. This statistic also holds true for numerous ECOWAS nations. Many foreign funding sources that contribute large amounts of aid to West African countries operate cyclically and can at times cut funding without the host country being prepared to absorb the financial impact. Even more concerning is the high percentage of funding that comes from out of pocket expenses. Sixty percent of health expenses are paid for out of pocket in Africa. These expenses can come in the form of user fees at public facilities, direct payments to private providers and even cash payments to traditional healers.

Numerous West African nations struggle with developing revenue streams to finance their healthcare systems. User fees are currently a source of revenue for West African governments. Although many primary care services are exempt from fees (immunizations, family planning, treatment of communicable disease), it still has proven a burden to care for many poor families. User fees have shown to be largely unpopular and many ECOWAS nations are currently exploring their abolishment. With the abolishment of fees comes the need to find a suitable source of additional revenue which can be quite difficult for low income nations.

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Global Health Africa was created by two global health professionals – Sophie Okolo and Ifeoma Ozodiegwu – in 2012. With a focus on Africa, these two global health enthusiasts spotlighted unexplored health issues such as autism, elderly abuse, dementia, and neglected tropical diseases on the blog. As their interests evolved, Sophie and ... Continue reading →